Abscond Service Improvement Project

1. Abscond Service Improvement Project A Joint Project between NHS Walsall and Dudley and Walsall Mental Health Partnership Trust (DWMHPT) Roger Abnett Alison Hawkins Kirstie Macmillan

2. Background • Service improvement project • Subject choice • Joint approach

3. Background • Definition of “abscond” • Clarity of serious incident (SI) category

4. Aims • To identify risk reduction strategies across DWMHPT in order to reduce the incidence of absconds • To identify any cost incurred as a result of an abscond.

5. Objectives • Apply Healthcare Failure Mode and Effects Analysis (HFMEA) to the abscond process • Identify recommendations to reduce the risk of absconding • Develop abscond risk reduction strategies within DWMHPT • Apply costings to the process of an abscond

6. Literature Review • City 128 research • Costing model • Adopted to support initial aims • FMEA adapted in Healthcare

7. Methodology • Healthcare Failure Mode and Effects Analysis (HFMEA) • Proactive risk assessment technique • Drills down to the minutia

8. Sectioned Patient Admission Process Abscond Process

10. Findings • Costings • Annual cost per ward £4,761

11. Findings • Key themes • Lack of suitable and sufficient risk assessments • Lack of effective MDT meetings • Lack of appropriate and timely provision of patient information • Failure to follow local policies and procedures • Lack of assurance on the competencies of agency/ locum staff • Lack of assurance on the appropriateness and adherence with internal policies/ processes and protocols

12. Recommendations • Review the structure and purpose including the terms of reference of the MDT meetings within DWMHPT • Review the provision of risk assessment training • Audit the quality aspect of risk assessments • Ensure missing persons policies and observation policies are fit for purpose • Review the DWMHPT embedding lessons process to include audit of the process

13. Conclusion • Multifaceted process • Robust methodology • Underpinned by good governance • Improved patient safety • Value for money

14. References • The City 128 Study of Observation and Outcomes on Acute Psychiatric Wards www.sdo.nihr.ac.uk/files/project/61-final-report.pdf • Joint Commission: Using Healthcare Failure Modes and effects Analysis (2002) • VA National Centre for Patient Safety: The Basics of Healthcare Failure Mode and Effect Analysis (2002)

15. Contacts • Roger.Abnett@dwmh.nhs.uk • Alison.Hawkins@walsall.nhs.uk • Kirstie.Macmillan@walsall.nhs.uk

16. Any Questions?